Hospice considering structural change in Marin

The board of Hospice By The Bay — formerly Hospice of Marin — will meet on Monday, and some outside observers are concerned a vote may be imminent that would turn control of the nonprofit over to another entity, perhaps Sacramento-based Sutter Health.

"What I was told is that Sutter wants to buy Hospice By The Bay, and I just really think that is wrong," said Antonio Clementino, a Fairfax psychologist and Hospice By The Bay volunteer, who says he has a confidential source within the organization.

Tom Verkozen, a Corte Madera Realtor and long-time Hospice By The Bay volunteer, said any management change that reduced service "would break my heart. It really would."

Hospice board president Dennis Gilardi said, "Our August meeting is scheduled for this Monday. The agenda is not a public document."

Gilardi added, "The board of directors is the governing body and the board of directors has not made a decision on anything that we want to publicly disclose."

Sutter Health did not respond to a request for comment.

Hospice By The Bay, which has offices in Corte Madera and Larkspur, provides supportive but not curative care to individuals who have been diagnosed with six months or less to live; pain and symptom management for patients with chronic or life-limiting illness, including children as young as newborns; and grief counseling.

Lost access?

Although the bulk of Hospice By The Bay's services are paid for by Medicare, the organization turns no one away due their inability to pay. In fiscal 2012-14, the organization supplied about $500,000 in charity care, said Hospice By The Bay CEO Kitty Whitaker. Clementino said he worries that if Sutter or some other organization assumes control of Hospice By The Bay that people at the bottom of the economic ladder may lose access to hospice services.

While Gilardi was unwilling to discuss the deliberations of the Hospice By The Bay's board, he was candid about the fact that he thinks the organization faces rough seas ahead and needs to adjust its course.

In spring of 2013, federal sequestration resulted in a 2 percent cut in Hospice By The Bay's medicare reimbursement, which translated into $600,000 in lost revenue annually. Prior to that, federal funding for hospice care had been decreasing 1 percent per year since fiscal year 2009-10.

In addition, Gilardi said Hospice By The Bay faces competition from other providers, some of them for-profit operations, for Medicare dollars.

Gilardi said for almost 40 years Kaiser patients in Marin used Hospice By the Bay exclusively, until "Heartland Hospice, a for-profit, came in and started eroding our market share. Under Medicare rules, Kaiser has to provide choices to the patients."

Gilardi said the for-profit operations market aggressively and the advertising is effective since most people don't realize there is a difference between the level of service provided by Hospice By The Bay and for-profit operators.

"If you put a lot of advertising into a beer, that beer's sales are going to go up," Gilardi said.

Looking at options

Board member Gerald Peters, a lawyer representing health care clients, said he missed the board's previous meeting, but he said he doubts the board would be making a final decision on anything on Monday.

"We've been looking at a bunch of strategic options, Sutter is one of them," Peters said. "I think we're supposed to be getting a report at this next board meeting on all of them, and it wouldn't surprise me if we're trying to see which way we want to go tentatively."

Peters said Hospice By The Bay is currently in good financial shape. The organization is debt free, has assets totalling $25 million, and its revenue exceeds expenses. But Peters, a vocal opponent of the decision to operate Marin General Hospital as a public hospital, says the bigger question is what happens in five years.

"With the health care world changing and the volatility coming out of Obamacare, I think it is important for us to see how we can assure that the organization is financially strong enough to survive in the long run," Peters said. "If you have to affiliate, you usually want to do when you're in a position of strength, because you can negotiate better terms."

When asked if the board is willing to guarantee that it won't enter into any deal that would jeopardize hospice care for those who can't afford it, Gilardi said, "We're going to do everything we can to protect the philanthropic assets and reserves and accumulated earnings of our organization for continued use to provide the highest quality end of life care."